Health warning on antibiotic resistant Shigella

What is the issue?

There are an increasing number of shigellosis cases in Victoria infected with strains of Shigella bacteria that are resistant to key recommended antibiotics. Many cases are occurring among men who have had recent sexual contact with other men. It is also being seen among returned travellers.

Antibiotic resistant infections are a serious public health problem because infections are harder to treat.

Who is at risk?

Men who have had recent sexual contact with other men; and returned travellers from countries with high rates of infection are at higher risk of contracting shigellosis, including from antibiotic-resistant Shigella strains.

Symptoms and transmission

Shigellosis is a bowel infection characterised by an acute onset of diarrhoea (which may be watery or contain traces of pus, mucous or blood), fever, nausea, vomiting and abdominal cramps. It is usually a self-limiting infection, however severe illness and complications can occur in certain at-risk individuals, such as young children, older people and those who are immunocompromised.

Shigellosis is highly contagious and is mainly transmitted through the faecal-oral route, including during sexual contact, especially oral sex and oro-anal sex. Symptoms usually develop one to three days following exposure but can occur as early as 12 hours to as late as one week afterwards in some cases.

Cases remain infectious while the Shigella bacteria continue to be shed in faeces. This can last for up to four weeks after symptoms resolve.

Treatment

Treatment includes plenty of fluids and oral rehydration drinks. Antibiotic treatment may be required for cases of severe infection.

Recommendations

For the public

• Practicing safer sex (e.g. using barrier protection) and good hygiene can prevent the spread of shigellosis.
• Wash your hands often and thoroughly, especially after using the toilet and before eating or preparing food.
• Wash your hands before and after sex and after handling used condoms or sex toys.
• If you have gastrointestinal symptoms, avoid having sex, preparing food or drink for others, or providing personal care for others until 48 hours after symptoms resolve.
• Men who have sexual contact with other men and returned overseas travellers should be aware of the symptoms of shigellosis and seek medical care if symptoms develop. Shigellosis can be diagnosed with a stool sample.
• People who have been diagnosed with shigellosis should abstain from sex while symptomatic and for one week after symptoms completely resolve. For a further two weeks after symptoms resolve:
  • Use barrier protection (such as condoms and dams) during sex
  • Limit sexual activities with faecal-oral exposure, such as rimming, which may significantly increase the risk of spreading infection
  • Shower and wash hands before and after sex
• People who work as food handlers, childcare workers, healthcare workers, and people who work in a residential facility such as aged care facilities, disability group homes, prisons, and other residential facilities, should not return to work until advised by their Local Public Health Unit.

For clinicians

• Clinicians should request a stool culture when investigating for shigellosis.
• Antibiotic treatment should be reserved for cases of severe infection or those who are immunocompromised.
• Antibiotic choice should be based on susceptibilities and advice should be sought from an infectious disease specialist or microbiologist as antibiotic resistance varies by region and over time.
• Local Public Health Units are following up people diagnosed with antibiotic-resistant Shigella infections and their contacts to provide advice about symptom monitoring, testing and exclusion requirements.
• Patients should be advised to maintain good hygiene and safer sex practices, avoid preparing food for others and be excluded from work if they are a priority case until cleared by their Local Public Health Unit.
• Clinicians and pathology services must notify the Department of Health of any cases of shigellosis within five days of diagnosis. Notifications can be made onlineor faxed on 1300 651 170.

More information

Clinical information

For more information, see Shigellosis, call the Communicable Disease Section of the Department of Health on 1300 651 160 or contact the relevant Local Public Health Unit undertaking public health management of the patient.

Consumer information

For more information, please visit the Better Health Channel webpage on Gastroenteritis – shigellosis.

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